Shackelford, Stacy Ann

Shackelford, Stacy Ann is an individual health care provider with primary practice located at 4102 Pinion Dr , Usaf Academy CO 80840-2502. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Trauma Surgery. Allopathic & Osteopathic Physicians / Trauma Surgery is her primary health care specialty. Shackelford, Stacy Ann can be contacted via phone (719) 333-5140.

Contact Information

Primary practice address
4102 Pinion Dr Usaf Academy CO 80840-2502
Phone: (719) 333-5140
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 280123-1205 Utah
Allopathic & Osteopathic Physicians / Trauma Surgery 2086S0127X DR.0068946 Colorado

Profile Details

NPI number 1215925672
LBN Legal business name Shackelford, Stacy Ann
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2005
Last updated Oct 30th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215925672 NPPES
Maryland MEDICAID 441150100

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